The first part of this two-part webinar on “Effectiveness and Cost-Effectiveness of Small-Quantity Lipid-Based Nutrient Supplements (SQ-LNS) for Preventing Child Malnutrition, Improving Child Survival and Promoting Healthy Development” took place on May 4. Participants discussed “The evidence base for efficacy and effectiveness of SQ-LNS: Who benefits most?”
A new study published in Social Science & Medicine by Prado and colleagues shows that maternal depression is the predominant persistent risk for child cognitive and social-emotional problems from early childhood to pre-adolescence.
Many studies have examined the consequences of the timing of linear growth faltering for children’s cognitive outcomes and whether catch-up in growth is associated with catch-up in cognitive development. Less is known about the timing of exposures to other risks and their developmental consequences.
This question is especially important because the middle childhood years (age 5-9) have been largely neglected in public health programs and research in low- and middle-income countries (LMICs). An essential package of interventions for children age 5-14 has been proposed, which includes health interventions, such as deworming and tetanus vaccination, as well as dietary interventions, such as school feeding programs and micronutrient supplementation (Bundy et al. 2018).
In a longitudinal cohort of 359 children in Indonesia, we examined the developmental consequences of the timing of exposure to four risk factors: linear growth faltering, low hemoglobin, inadequate home environment, and maternal depressive symptoms.
We observed variation in continuity of exposure to risks from age 3.5 to 9-12 years. Some children were exposed to early risks then experienced improved conditions. Others experienced positive conditions early with late-onset risk, while others were chronically exposed to high-risk or low-risk environments.
Exposure to maternal depressive symptoms was the only risk factor that was associated with both cognitive and social-emotional problems during both early childhood and pre-adolescence. At age 9-12 y, children of mothers who had persistent high depressive symptoms showed very high social-emotional problems, more than 1 SD above the overall mean.
Early childhood home quality was also a major risk, with children in high quality homes scoring 8 IQ points above those in low quality homes.
Low hemoglobin concentration during both early childhood and pre-adolescence was associated with cognitive outcomes, but no associations were found with linear growth faltering when adjusting for other risk exposures.
While the essential package of interventions for children age 5-14 has focused on biomedical risks, supporting children to fulfill their developmental potential will require interventions that also address socio-environmental risks, such as promoting maternal mental health and responsive care and learning opportunities in the home environment.
The Nurturing Care Framework is evidence-based multilayered dynamic framework that promotes human capital development from preconception to early childhood through stable environments. According to the framework, the five essential components of such environments are those that (1) promote health, (2) provide adequate nutrition, (3) ensure safety and provide protection from threats, (4) ensure opportunities for learning, and (5) ensure relationships that are emotionally supportive and responsive. A new paper recently published in the BMJ Global Health, which was led by Maureen Black and co-authored by Elizabeth Prado, extends this framework from preconception through adolescence.
Attaining the Sustainable Development Goals depends on strengthening human capital formation. Embedded in enabling laws, policies and services, the dynamic components of the Nurturing Care Framework can mitigate adversities, enhance resilience and promote the well-being of marginalized groups. The life-course extension of the Nurturing Care Framework is strategically positioned to enhance human capital, to attain the Sustainable Development Goals and to ensure that children and adolescents are not left behind in reaching their developmental potential.
Prado and collaborators published “Supporting children to grow smarter, not just taller: here’s how” in Early Childhood Matters. Read the article at the Early Childhood Matters website.
Thursday, November 12, 2020
1:30 PM – 3:00 PM EST
Friday, November 20, 2020
11:00 AM – 12:00 PM EST
A paper just published in the Journal of Nutrition reports the first study to use automated eye tracking to measure infant developmental outcomes of a nutrition randomized trial. Effects of early nutrition on infant neurobehavioral development are typically measured using assessment of behavioral milestones, such as crawling and saying words. These assessments may not be highly sensitive to individual differences between children because there is a wide range of variability in the age children attain these milestones that is normal. Children’s scores on these types of measures during the first two years after birth are not strongly correlated with children’s later cognitive abilities.
Measures of infant looking behavior may be more sensitive than measures based on milestone attainment. Infants’ eye gazes provide meaningful information about their cognitive processing. For example, an infant’s novelty preference, demonstrated by looking longer at a new picture compared to a previously seen picture, shows that the infant remembers the previously seen picture. Automated eye trackers detect the gaze focal point using an infrared light source and a set of cameras that capture the light reflected from the cornea. Recent advances have made this technology more feasible for use in low- and middle-income country settings. In this study, we used automated eye tracking to assess infant cognition in Malawi, in combination with commonly-used developmental assessments based on acquisition of behavioral milestones.
The trial was designed to test whether feeding children eggs during the complementary feeding period improves growth and development and was funded by the Bill & Melinda Gates Foundation. The trial was led by Dr. Christine Stewart at the UC Davis Institute for Global Nutrition and Dr. Kenneth Maleta at the University of Malawi College of Medicine, with the developmental outcomes led by Dr. Elizabeth Prado at the UC Davis Institute for Global Nutrition in collaboration with Dr. Lisa Oakes at the UC Davis Center for Mind and Brain.
Eggs are nutrient-rich foods, which have been found to promote child growth in Ecuador. We enrolled 660 children age 6-9 months in rural Malawi and randomly assigned half of the children to the intervention group, who received seven eggs per week for the study child and seven eggs per week for the household, and half of the children to the control group, who did not receive eggs. After six months, we did not find any differences between the group who received eggs and the control group in attention, memory, language, motor, or personal-social skills, except a smaller percentage of children who received eggs had delayed fine motor skills, such as picking up small objects with their fingers. This study highlights that positive effects of egg interventions may be found in some contexts but not others, which should be considered when deciding whether to invest in programs to promote child egg consumption. Although we did not find effects of the intervention on the eye-tracking measures, we successfully obtained usable data from 60% of targeted children at age 6-9 months and 72% of targeted children at age 12-15 months. These success rates were obtained in the context of a full day of data collection and project activities for the participants, with as many as 25 participants assessed on any given day. This suggests that automated eye tracking is a new promising method to evaluate early child development in nutrition research in low- and middle-income countries.
On February 27, 2020, Dr. Elizabeth Prado and Dr. Seth Adu-Afarwuah launched a new project in Ghana funded by $2,600,000 from the US National Institutes of Health. The project will be the first long-term follow-up in Africa of a randomized controlled trial in which the intervention group received a fortified food during most of the first 1000 days, from early pregnancy through 18 months of age.
Nutrients such as vitamins, minerals, and fatty acids are the building blocks for children’s healthy brain development. Much of the brain’s structure is laid during pregnancy and early childhood, when the brain and nervous system are developing very rapidly. Many pregnant women and young children do not eat sufficient nutrient-dense foods that contain these essential nutrients. If these nutrients are not available during critical periods when the brain is developing rapidly, there could be long-term effects on the structure and function of the brain and nervous system.
This new project will follow up children at 8-12 years of age whose mothers participated in a randomized controlled trial of nutritional supplementation when they were pregnant 10 years ago. The original trial, the International Lipid-Based Nutrient Supplements (iLiNS) DYAD (mother-child dyad) trial, was led by Dr. Kay Dewey at UC Davis and Dr. Anna Lartey at the University of Ghana and was funded by the Bill & Melinda Gates Foundation. Pregnant women and children in the intervention group received lipid-based nutrient supplements (LNS), made from peanut paste, vegetable oil, and milk powder, with added vitamins and minerals. While small-quantity LNS provides only a small amount of calories per day (~118 kcal), it is packed with the vitamins, minerals, and fatty acids that are needed for children’s growth and development. In the control groups, women received a daily micronutrient capsule, similar to a pre-natal multi-vitamin, and the children did not receive any supplement.
When the children were 4-6 years of age, we found that children in the LNS group had fewer social-emotional difficulties compared to the control groups, especially those from home environments with low nurturing care and learning opportunities. The aims of the new project are to see whether we find the same pattern when the children are 8-12 years of age and to understand the neural mechanisms of protective effects of early nutrition on the development of social-emotional difficulties among children in Ghana. This will be the first randomized controlled trial to assess long-term effects of early nutritional supplementation on nervous system development through combining methods to assess neurophysiology in both the central and autonomic nervous systems, including structural magnetic resonance imaging (MRI) with diffusion tensor imaging (DTI) and measures of autonomic nervous system (ANS) activity, including electrocardiogram and impedance cardiography. Co-investigators are Dr. Paul Hastings and Dr. Amanda Guyer at UC Davis, Dr. Adom Manu and Dr. Benjamin Amponsah at the University of Ghana, and Dr. Brietta Oaks at the University of Rhode Island.
Study Looks at Preventing Stunted Brains, Not Just Stunted Growth
A new study led by researchers at the University of California, Davis, shows that caregiving programs are five times more effective than nutrition programs in supporting smarter, not just taller, children in low- and middle-income countries.
The research, published in the journal The Lancet Global Health, examined 75 early intervention programs and their effects on children’s growth and brain development. Researchers have known adequate nutrition during pregnancy and childhood improve both conditions. But children growing up in poverty face a variety of risk factors that could govern growth and development differently.
“Our study found that we can’t just focus on nutrition. Other aspects of nurturing care are just as, if not more important in supporting healthy brains,” said lead author Elizabeth Prado, assistant professor of nutrition at UC Davis.
Prado says interventions that promote caregiving and learning, such as parents playing games, singing songs and telling stories with their children, have far bigger effects on children’s cognitive skills, language skills and motor development.
“We knew that nurturing care was important but were struck by how big its benefits were compared to nutrition and growth,” added Leila Larson, a lead collaborator from the University of Melbourne.
Investing in caregiving and learning
Global health programs typically focus on preventing stunting, when children are not growing in height the way they should for their age. Stunted growth has also been associated with lower than average school achievement and cognitive scores.
“The association has been influential in prioritizing a global agenda to promote nutrition and growth,” said senior author Anuraj Shankar, with the Center for Tropical Medicine and Global Health at Oxford University. “However, our true goal isn’t just for children to grow taller but for them to fulfill their developmental potential. The study shows that won’t happen unless we target caregiving to nurture thriving individuals and communities.”
Globally, an estimated 156 million children younger than 5 years have stunted growth and an estimated 250 million are at risk of not fulfilling their developmental potential.
Elizabeth Prado, UC Davis Department of Nutrition, 301-697-9542, email@example.com
Amy Quinton, UC Davis News and Media Relations, 530-752-9843, cell 530-601-8077, firstname.lastname@example.org
Karen Nikos-Rose, UC Davis News and Media Relations, 530-219-5472, email@example.com
Anuraj Shankar, Center for Tropical Medicine and Global Health, Oxford University, 617-955-6724, firstname.lastname@example.org
In the American Journal of Clinical Nutrition, Ocansey and colleagues report that lipid-based nutrient supplements (LNS) provided to pregnant women and their children from 0-18 months in Ghana reduced social-emotional problems 5 years later, compared to groups who received only micronutrients. Children with lower home environment scores showed the greatest benefits of LNS, suggesting that early nutritional supplementation buffered the effect of a poor home environment on the development of behavioral problems. This study is the first long-term follow-up of a randomized controlled trial of both prenatal and postnatal LNS supplementation, and suggests that such supplementation may be part of an effective strategy to prevent the development of behavioral problems.
In the BMJ Global Health, Prado and colleagues reported factors that contribute to linear growth faltering in 4 longitudinal cohorts of young children, totaling more than 4000, in Ghana, Malawi, and Burkina Faso. We found consistent associations of 18-mo LAZ with maternal height and maternal body mass index (BMI) in 3-4 cohorts. The factors with the strongest associations with 18-mo LAZ were length for gestational age z-score at birth, maternal height, and gestational age at birth. Other factors that showed significant associations with 18-mo LAZ in 2 cohorts, though with smaller coefficients, were improved household water source, child dietary diversity, childhood diarrhea incidence, and 6 or 9-mo hemoglobin concentration. Interventions targeting these factors associated with LAZ may accelerate progress toward reducing stunting, however, much of the variance in linear growth status remained unaccounted for by individual-level factors suggesting that community-level changes may be needed to achieve substantial progress and further research is needed to understand the causes of stunting.